Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients

Abstract

Total arch repair with open triple-branched stent graft placement is an effective technique with satisfactory early and midterm results. This technique could be an attractive alternative to conventional total arch replacement.

A self-adaptive triple-branched stent graft for arch repair during open type A dissection surgery

“…For the effective arch repair with open triple-branched stent graft placement, the directions and diameters of 3 arch vessels, the distances between 2 neighboring arch vessels, and the tortuosity and diameter of the arch must be fitted by the prefabricated triple-branched stent graft. [3][4][5][6][7] Because all those are different in different cases, an ideal triple-branched stent graft should be versatile enough to satisfy the requests of individual total arch repairs for most patients. In our practice with the first generation of triple-branched stent graft for arch repair in more than 100 patients with acute type A aortic dissection, we found that the diameters of 3 arch vessels could be easily matched by our prefabricated triple-branched stent grafts with the aid of banding at the bases of the arch vessels, and a difficult match occurred in the directions of 3 arch vessels, the distances between 2 neighboring arch vessels, and the tortuosity and diameter of the arch.…”

“…In our practice with the first generation of triple-branched stent graft for arch repair in more than 100 patients with acute type A aortic dissection, we found that the diameters of 3 arch vessels could be easily matched by our prefabricated triple-branched stent grafts with the aid of banding at the bases of the arch vessels, and a difficult match occurred in the directions of 3 arch vessels, the distances between 2 neighboring arch vessels, and the tortuosity and diameter of the arch. 6 On the basis of these findings, a self-adaptive triple-branched stent graft, which could fit the different directions of 3 arch vessels, the various distances between 2 neighboring arch vessels, and the different tortuosity and diameter of the arch, was used in this study.…”

“…6,8 All patients underwent a median sternotomy and total cardiopulmonary bypass. Two arterial return cannulas were placed in the right axillary and femoral arteries.…”

“…1,2 With this new technique, the risk and technical difficulty of simultaneous ascending aortic replacement and total arch repair can be reduced to approximate those of the conventional ascending graft replacement with open distal anastomosis. [3][4][5][6] Therefore, this new technique may be a good arch repair approach for acute type A aortic dissection. However, the difficulty in producing many samples of the triple-branched stent graft has limited this new technique from widespread application in most patients, because the directions and diameters of the arch vessels, the distances between 2 neighboring arch vessels, and the tortuosity and diameter of the arch are different in different cases.…”

“…However, the difficulty in producing many samples of the triple-branched stent graft has limited this new technique from widespread application in most patients, because the directions and diameters of the arch vessels, the distances between 2 neighboring arch vessels, and the tortuosity and diameter of the arch are different in different cases. 6,7 Moreover, placement of a triple-branched stent graft into the true lumen of the proximal descending aorta, arch, and 3 arch vessels through the transverse incision of the distal ascending aorta was difficult in some patients. 7 To make this simple technique suitable for most patients with acute type A aortic dissection to achieve effective individual total arch repair, a self-adaptive triple-branched stent graft and arch open technique were developed.…”